Our Anesthesia Experience in Very Low Birth Weight Prematures with Necrotizing Enterocolitis Perforation.

Background: Necrotizing enterocolitis (NEC) is a serious, life-threatening pathology seen especially in the neonatal period. It is characterized by inflammation of the intestinal mucosa and ischemic necrosis. When it progresses, intestinal perforation can lead to peritonitis, sepsis, and even to death (50%). We present our anesthesia practices in 5 premature patients with very low birth weight (VLBW) (<=1500 g) who underwent surgery for intestinal perforation after NEC. Case report: All patients were ASA V E and in need of invasive respiratory support with cardiac and respiratory co-morbidities. The demographic and peroperative data of the patients are shown in the table. Gas distention and dilated bowel loops were observed in the abdomen on radiological imaging. Transfers to the operating room were provided in a heated incubator with a transport ventilator and monitor. Inotropic support was continued during transport. The operating room and operating table were preheated. ECG, SpO2, noninvasive blood pressure and body temperature monitoring was achieved. Inotropic support was continued. Fluid management was provided with 3.33% dextrose-0.3% sodium chloride. Four extremities and head circumferences were wrapped with cotton to reduce heat loss. Since the patients were hemodynamically labile, ketamine was generally preferred for anesthesia induction and maintenance. Pressure-controlled mechanical ventilation was administered with neonatal breathing circuits. No patient needed muscle relaxants. After surgery, all patients were successfully transferred to the intensive care unit. Discussion: Many factors may be responsible for the etiology of NEC, but the strongest risk factor is prematurity. The morbidity and mortality rates are higher in patients requiring surgical intervention. Interventions to prevent NEC development are the most effective way to avoid negative consequences. Preventive interventions should start from the maternal period and include the intensive care hospitalization and the arrival to the operating room. The transfers of VLBW prematures between the intensive care and the operating room, operating room preparation and anesthesia applications require more caution. Conclusion: Detailed and careful preparation, communication between teams and a multidisciplinary approach are required to achieve success in these babies with high mortality and morbidity rates. [ABSTRACT FROM AUTHOR]